PR-1CARCNon-appealable
Patient ResponsibilityDeductible Amount
Deductible amount applied to patient responsibility. The payer processed the claim but payment is reduced by the patient's unmet annual deductible.
What This Means in Behavioral Health
BH residential claims often apply large deductible amounts to institutional per diem lines. Admissions teams need deductible status before financial conversations—PR-1 on remittance confirms patient owes until deductible is met.
Common levels of care
- RTC
- PHP
- IOP
- Detox
- Outpatient
Root Causes
- Patient deductible not yet satisfied for plan year
- Deductible applies to BH benefit separately from medical deductible on some plans
- Family vs individual deductible aggregation misunderstood at admission
- Incorrect deductible amount quoted during VOB
Prevention Tips
- Include deductible remaining in admission VOB summary
- Post PR-1 to patient ledger promptly with clear statements
- Re-run eligibility in January and on plan year resets
- Coordinate financial counseling for high-deductible plans before RTC admit
Getting PR-1 Denials Under Control
Prevention at the source
Utilization review services
Concurrent review, authorization management, and medical-necessity documentation that stop authorization and necessity denials before the claim bills.
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